CCDS Clinical Coding 2 — Questions and Answers
Question 1: Under ICD-10-PCS, which of the seven characters defines the specific approach used for a procedure?
- Character 3 (Root Operation)
- Character 4 (Body Part)
- Character 5 (Approach) (Correct answer)
- Character 6 (Device)
Correct answer: Character 5 (Approach)
In ICD-10-PCS, Character 5 specifies the approach used to reach the operative site, such as open, percutaneous, endoscopic, or via natural or artificial opening.
ICD-10-PCS is a 7-character system where each character has a defined meaning. Character 5 (Approach) defines how the procedure site was accessed: Open (0), Percutaneous (3), Percutaneous Endoscopic (4), Via Natural or Artificial Opening (7), Via Natural or Artificial Opening Endoscopic (8), External (X).
Question 2: A patient undergoes a laparoscopic cholecystectomy that is converted to an open procedure. How should this be coded in ICD-10-PCS?
- Code only the laparoscopic approach since it was the intended approach
- Code only the open approach since it was the completed procedure (Correct answer)
- Code both the laparoscopic and open approaches with separate PCS codes
- Code the procedure as percutaneous endoscopic converted to open with a single code
Correct answer: Code only the open approach since it was the completed procedure
Per ICD-10-PCS guidelines, when a procedure is converted from a laparoscopic to an open approach, only the open approach procedure code is assigned. The laparoscopic portion that did not complete the intended procedure is not separately coded.
ICD-10-PCS Official Guidelines state that when a planned procedure is converted to a different approach, only the approach that successfully completed the procedure is coded. In a laparoscopic-to-open conversion, the completed open cholecystectomy is coded with the open approach character (0).
Question 3: Which ICD-10-CM code category is used to report sepsis due to a gram-positive organism when the specific organism is identified?
- A40 - Streptococcal sepsis
- A41 - Other sepsis (Correct answer)
- R65.2 - Severe sepsis
- A02.1 - Salmonella septicemia
Correct answer: A41 - Other sepsis
Category A41 (Other sepsis) covers sepsis due to specific organisms including Staphylococcus aureus. The specific organism code from A40-A41 is sequenced first, followed by R65.2x if severe sepsis criteria are met.
ICD-10-CM coding guidelines for sepsis require coding the underlying systemic infection first (A40.x for Streptococcal, A41.x for other organisms). The specific code within A41 depends on the identified organism: A41.01 for MRSA, A41.02 for MSSA, A41.1 for sepsis due to other Staphylococci.
Question 4: What is the ICD-10-CM convention for coding a condition that is integral to a disease process?
- It is coded separately with a note indicating it is integral
- It is not coded separately, as it is inherent to the condition (Correct answer)
- It is coded with an additional external cause code
- It is sequenced as the principal diagnosis
Correct answer: It is not coded separately, as it is inherent to the condition
ICD-10-CM Guideline Section I.B.5 states that signs and symptoms that are integral to a disease process should not be assigned as additional codes unless otherwise instructed by the classification.
The ICD-10-CM convention for integral signs and symptoms prevents redundant coding. When a symptom or finding is routinely associated with a disease such as dyspnea with COPD exacerbation, it is considered integral and should not be coded as an additional diagnosis.
Question 5: A patient is admitted with acute respiratory failure due to pneumonia. Which is the correct sequencing under ICD-10-CM inpatient guidelines?
- Sequence pneumonia as principal diagnosis in all cases
- Sequence acute respiratory failure as principal diagnosis in all cases
- Either condition may be sequenced as principal diagnosis per coding guideline discretion (Correct answer)
- Sequence whichever condition was treated with the most resources
Correct answer: Either condition may be sequenced as principal diagnosis per coding guideline discretion
ICD-10-CM guideline I.C.10.b states that when both respiratory failure and another condition such as pneumonia are equally responsible for the admission, either may be sequenced as the principal diagnosis.
ICD-10-CM Section I.C.10.b specifically addresses respiratory failure as principal diagnosis, noting that when a patient is admitted with both respiratory failure and another condition, and both contributed equally to the admission, the coder may sequence either as the principal diagnosis.
Question 6: Which ICD-10-PCS root operation is used when a surgeon removes a kidney stone using an endoscope introduced through the urethra?
- Excision
- Extirpation (Correct answer)
- Fragmentation
- Extraction
Correct answer: Extirpation
Extirpation is the root operation for taking or cutting out solid matter such as a calculus from a body part. For a kidney stone removed via endoscopic approach through the urethra, Extirpation with a via natural or artificial opening endoscopic approach would be coded.
ICD-10-PCS defines Extirpation as taking or cutting out solid matter from a body part. Kidney stones, calculi, thrombi, and retained foreign bodies are all coded with Extirpation. This is distinct from Excision (cutting out a portion of a body part) and Extraction (pulling or stripping out matter).
CCDS Clinical Coding 2
Under ICD-10-PCS, which of the seven characters defines the specific approach used for a procedure?